Women who stop taking antidepressants during pregnancy are five times
more likely to have relapse of depression than women who continue the
medication throughout their pregnancy. According to Lee Cohen, MD,
director of the Perinatal and Reproductive Clinical Research Program at
Massachusetts General Hospital (MGH), who led the investigation
“Clinical lore has held for decades that pregnancy protected women from
mood disorders.”

The findings from the first systematic clinical study of depression
relapse runs counter to the long held belief that hormonal changes can
prevent psychiatric problems. Dr. Cohen said "What drove this study was
a divergence between that belief and what many of us were seeing
clinically, that many women who stopped using antidepressants during
pregnancy appeared to be relapsing."

According to the MGH press release, many published studies have
supported the safety of antidepressant drugs taken while pregnant.
There have been some reports of prenatal exposure to the popular
selective serotonin reuptake inhibitors (SSRIs). These exposures could
cause transient agitation or distress in newborns, according to MGH.

Recently there have been unpublished reports suggesting a potentially
increased risk of cardiovascular defects in infants exposed to the SSRI
paroxetine. The MGH study was intended to evaluate the risk of
recurrent depression in pregnant women who chose to continue or to stop
antidepressants during pregnancy.

The MGH study enrolled 201 women treated at the women’s mental health
centers at MGH, the University of California Los Angeles (UCLA) and the
Emory University School of Medicine. These participants were less than
16 weeks pregnant when entering the study and had a history of
depression. Each had been successfully treated for depression with
antidepressant medications for at least three months prior to becoming
pregnant.

Out of the 201 participants, 82 chose to maintain their medication
dosage, 65 quit their medication, 34 decreased their dosage and 20
increased their dosage during their pregnancies. There were 43 relapses
of depression with half of them occurring during their first trimester.

The researchers compared the groups. Their results were as follows: 68
percent of the women who discontinued their medications relapsed, while
26 percent of the women who maintained their pre-pregnancy dosage had a
“recurrence of symptoms”.

Dr. Cohen said "While this report does not offer explicit guidelines for
individual patients, the study unequivocally suggests that women taking
antidepressants who anticipate pregnancy need to address with their
doctors not only potential risks to their babies if they continue taking
the drugs but also the risk that their disease may recur if they stop
antidepressants. Only by considering both sides of this risk/benefit
equation can patients make informed decisions."

The researchers are analyzing the data in a hope to determine the
characteristics that may point to a decision on who can discontinue the
antidepressants and who will have relapses if they do discontinue.
There are risks either way, and it may help women make an informed
decision.